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CREW LIST

(IMO FAL Form 5)

Arrival Departure Page Number


1.1 Name of ship 1.2 IMO number 1.3 Call sign 1.4 Voyage number

`2. Port of arrival/departure 3. Date of arrival/departure 4. Flag State of ship 5. Last port of call

6. No. 7. Family name 8. Given 9. Rank or 10. Nationality 11. Date 12. Place 13. Gender 14. Nature 15. Number 16. Issuing State of 17. Expiry date
names rating of birth of birth of identity of identity identity document of identity
document document document
18. Date and signature by master, authorized agent or officer

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